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Heller myotomy

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https://www.readbyqxmd.com/read/29156013/a-novel-strategy-to-initiate-a-peroral-endoscopic-myotomy-program
#1
J Matthew Reinersman, Dennis A Wigle, Christopher J Gostout, Louis M Wong Kee Song, Shanda H Blackmon
OBJECTIVES: The standard of care for achalasia remains laparoscopic Heller myotomy with partial fundoplication. Peroral endoscopic myotomy (POEM) has been introduced as an alternative, but safety and long-term comparative efficacy are not yet established. We report our experience in developing a POEM program using a novel hybrid approach. METHODS: We developed a hybrid approach to POEM with a POEM followed by laparoscopic evaluation, extension of the myotomy, if necessary, and partial fundoplication...
October 1, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29142537/pneumatic-balloon-dilatation-for-achalasia-cardia-early-late-results-a-single-center-study
#2
S Waqar H Shah, Arshad K Butt, K Malik, Altaf Alam, Anwaar A Khan
Objective: Achalasia Cardia is treated by Pneumatic balloon dilatation, Heller's Myotomy and recently, by Peroral Esophagaeal Myotomy. This study reports the efficacy of pneumatic balloon dilatation as a non-surgical motility in achieving relief of dysphagia, clinical improvement and recurrence. Long-term complications were reported. Methods: Eight hundred ninety two adult achalasia patients of both genders were treated from January 1988 till December 2011, with pneumatic balloon (Rigiflex Microvasive(®)) dilatation, under fluoroscopy Barium swallow was obtained prior to and five minutes after dilatation to evaluate for efficacy of dilatation as well as for complications...
September 2017: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/29136668/endoscopic-submucosal-dissection-of-a-squamous-cell-carcinoma-of-the-esophagus-developing-in-the-area-of-a-previous-heller-s-myotomy-for-achalasia
#3
Dario Biasutto, Jérôme Rivory, Sabine Roman, François Mion, Jean-Christophe Saurin, Thierry Ponchon, Mathieu Pioche
No abstract text is available yet for this article.
November 14, 2017: Endoscopy
https://www.readbyqxmd.com/read/29135385/redo-laparoscopic-heller-s-cardiomyotomy-for-recurrent-achalasia-is-laparoscopic-surgery-feasible
#4
Pranav Mandovra, Vishakha Kalikar, Ankur Patel, Roy V Patankar
BACKGROUND: Achalasia cardia is an esophageal motor disorder with raised lower esophageal sphincter (LES) pressure. Minimally invasive procedures have become the procedure of choice compared with conventional open surgery. After the primary surgery, recurrence or persistent symptoms have been noted in almost 10%-20% of cases. MATERIALS AND METHODS: In this case series, we share our experience with a series of 7 patients who presented to us from January 2010 to January 2017 for recurrent symptoms, following Heller's myotomy for achalasia cardia...
November 14, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/29122601/per-oral-endoscopic-myotomy-in-patients-with-or-without-prior-heller-myotomy-comparing-long-term-outcomes-in-a-large-u-s-single-center-cohort-with-videos
#5
Xiaocen Zhang, Rani J Modayil, David Friedel, Krishna C Gurram, Collin E Brathwaite, Sharon I Taylor, Maria M Kollarus, Sony Modayil, Bhawna Halwan, James H Grendell, Stavros N Stavropoulos
BACKGROUND AND AIMS: Heller myotomy (HM) is one of the most effective treatments for esophageal achalasia. However, failures do exist and the success rate tends to decrease with time. The efficacy of rescue treatments for patients with failed Heller is limited. A few small-scale studies have reported outcomes of per-oral endoscopic myotomy (POEM) in these patients. We conducted this study to systematically assess feasibility, safety, and efficacy of POEM on post-Heller patients. METHODS: Patients at least 3 months out from their POEM were selected from our prospective database: 318 consecutive POEMs performed from October 2009 to October 2016...
November 6, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29102729/gastroesophageal-reflux-disease-after-per-oral-endoscopic-myotomy-as-compared-with-heller-s-myotomy-with-fundoplication-a-systematic-review-with-meta-analysis
#6
REVIEW
Alessandro Repici, Lorenzo Fuccio, Roberta Maselli, Fabrizio Mazza, Loredana Correale, Daniele Mandolesi, Cristina Bellisario, Amrita Sethi, Mouen Kashab, Thomas Rösch, Cesare Hassan
BACKGROUND AND AIMS: Per-oral endoscopic myotomy (POEM) represents a less invasive alternative, as compared with conventional laparoscopic Heller's myotomy (LHM), for achalasia patients. It cannot be excluded, however, that the lack of fundoplication after POEM may result in a higher incidence of reflux disease, as compared with LHM. The aim was to conduct a systematic review of prospective studies reporting the incidence of reflux disease developed after POEM and LHM. METHODS: Literature search with electronic databases was performed (up to February 2017) to identify full articles on the incidence of gastro-esophageal reflux symptoms, endoscopic- and pH-monitoring-findings after POEM and LHM (with fundoplication)...
November 1, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29089698/laparoscopic-heller-s-myotomy-for-achalasia-cardia-one-time-treatment-in-developing-countries
#7
Vishal Gupta, Hunaid Hatimi, Saket Kumar, Abhijit Chandra
Laparoscopic Heller's myotomy (LHM) and endoscopic balloon dilation are two main treatment modalities for achalasia cardia. The best treatment modality in Indian setting, however, is still unknown. Here, we present the early results of LHM in achalasia. Hospital data from January 2009 to October 2013 was analyzed. Preoperative assessment included Eckardt's scoring, esophagogastroduodenoscopy, barium swallow examination, and esophageal manometry. Thirty-five patients (19 males and 16 females, median age 31 years, range 12-65) underwent LHM with partial fundoplication (with intraoperative endoscopy)...
October 2017: Indian Journal of Surgery
https://www.readbyqxmd.com/read/29078682/the-current-state-of-per-oral-endoscopic-myotomy-for-achalasia
#8
REVIEW
Shane P Smith, Brian E Louie
Achalasia is an acquired neuromuscular disorder that has been treated using a variety of modalities throughout medical history. Recently, the technique of per oral endoscopic myotomy (POEM) was introduced to treat the disease using a truly minimally invasive, natural orifice technique that is rapidly being adopted across the world. This review outlines the development of POEM, the technique itself, and gives a comparison to other procedures, specifically laparoscopic Heller myotomy (LHM).
2017: J Vis Surg
https://www.readbyqxmd.com/read/29078570/robotic-technological-aids-in-esophageal-surgery
#9
REVIEW
Fabrizio Rebecchi, Marco E Allaix, Mario Morino
Robotic technology is an emerging technology that has been developed in order to overcome some limitations of the standard laparoscopic approach, offering a stereoscopic three-dimensional visualization of the surgical field, increased maneuverability of the surgical tools with consequent increased movement accuracy and precision and improved ergonomics. It has been used for the surgical treatment of most benign esophageal disorders. More recently, it has been proposed also for patients with operable esophageal cancer...
2017: J Vis Surg
https://www.readbyqxmd.com/read/29062443/the-choice-of-optimal-antireflux-procedure-after-laparoscopic-cardiomyotomy-two-decades-of-clinical-experience-in-one-center
#10
Mindaugas Kiudelis, Egle Kubiliute, Egidijus Sakalys, Laimas Jonaitis, Antanas Mickevicius, Zilvinas Endzinas
INTRODUCTION: Two types of partial wrap are commonly performed in achalasia patients after Heller myotomy: the posterior 270° fundoplication (Toupet) and the anterior 180° fundoplication (Dor). The optimal type of fundoplication (posterior vs. anterior) is still debated. AIM: To compare the long-term rates of dysphagia, reflux symptoms and patient satisfaction with current postoperative condition between two fundoplication groups in achalasia treatment. MATERIAL AND METHODS: Our retrospective study included 97 consecutive patients with achalasia: 37 patients underwent laparoscopic posterior Toupet (270°) fundoplication followed by Heller myotomy (group I); 60 patients underwent laparoscopic anterior partial Dor fundoplication followed by Heller myotomy (group II)...
September 2017: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
https://www.readbyqxmd.com/read/29046957/heller-myotomy-versus-heller-myotomy-with-dor-fundoplication-for-achalasia-long-term-symptomatic-follow-up-of-a-prospective-randomized-controlled-trial
#11
Kristy Kummerow Broman, Sharon E Phillips, Adil Faqih, Joan Kaiser, Richard A Pierce, Benjamin K Poulose, William O Richards, Kenneth W Sharp, Michael D Holzman
BACKGROUND: Our prior randomized controlled trial of Heller myotomy alone versus Heller plus Dor fundoplication for achalasia from 2000 to 2004 demonstrated comparable postoperative resolution of dysphagia but less gastroesophageal reflux after Heller plus Dor. Patient-reported outcomes are needed to determine whether the findings are sustained long-term. METHODS: We actively engaged participants from the prior randomized cohort, making up to six contact attempts per person using telephone, mail, and electronic messaging...
October 18, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/29019558/late-evaluation-of-dysphagia-after-heller-esophageal-myotomy-with-dor-fundoplication-for-achalasia
#12
Eduardo Rodrigues Zarco Câmara, Fernando Athayde Veloso Madureira, Delta Madureira, Renato Manganelli Salomão, Antonio Carlos Ribeiro Garrido Iglesias
BACKGROUND: All available treatments for achalasia are palliative and aimed to eliminate the flow resistance caused by a hypertensive lower esophageal sphincter. AIM: To analyze the positive and negative prognostic factors in the improvement of dysphagia and to evaluate quality of life in patients undergoing surgery to treat esophageal achalasia by comparing findings before, immediately after, and in long follow-up. METHODS: A total of 84 patients who underwent surgery for achalasia between 2001 and 2014 were retrospectively studied...
July 2017: Arquivos Brasileiros de Cirurgia Digestiva: ABCD, Brazilian Archives of Digestive Surgery
https://www.readbyqxmd.com/read/28989059/clinical-practice-update-the-use-of-per-oral-endoscopic-myotomy-in-achalasia-expert-review-and-best-practice-advice%C3%A2-from-the-aga-institute
#13
REVIEW
Peter J Kahrilas, David Katzka, Joel E Richter
The purpose of this review is to describe a place for per-oral endoscopic myotomy (POEM) among the currently available robust treatments for achalasia. The recommendations outlined in this review are based on expert opinion and on relevant publications from PubMed and EMbase. The Clinical Practice Updates Committee of the American Gastroenterological Association proposes the following recommendations: 1) in determining the need for achalasia therapy, patient-specific parameters (Chicago Classification subtype, comorbidities, early vs late disease, primary or secondary causes) should be considered along with published efficacy data; 2) given the complexity of this procedure, POEM should be performed by experienced physicians in high-volume centers because an estimated 20-40 procedures are needed to achieve competence; 3) if the expertise is available, POEM should be considered as primary therapy for type III achalasia; 4) if the expertise is available, POEM should be considered as treatment option comparable with laparoscopic Heller myotomy for any of the achalasia syndromes; and 5) post-POEM patients should be considered high risk to develop reflux esophagitis and advised of the management considerations (potential indefinite proton pump inhibitor therapy and/or surveillance endoscopy) of this before undergoing the procedure...
November 2017: Gastroenterology
https://www.readbyqxmd.com/read/28966450/comparison-of-outcomes-of-laparoscopic-heller-myotomy-versus-per-oral-endoscopic-myotomy-for-management-of-achalasia
#14
Steven G Leeds, J S Burdick, Gerald O Ogola, Estrellita Ontiveros
Achalasia is a rare disorder that has several treatment options. The gold standard of treatment is a surgical myotomy called a laparoscopic Heller myotomy (LHM). More recently, an endoscopic myotomy has become an option as well, called per-oral endoscopic myotomy (POEM). An achalasia registry was queried for patients undergoing either LHM or POEM at Baylor University Medical Center at Dallas. Patient demographics, preoperative and postoperative data points, and Eckardt scores were collected. The patients were further stratified into their follow-up intervals, immediate postoperative and long-term follow-up, to assess surgical success...
October 2017: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/28958274/age-and-achalasia-how-does-age-affect-patient-presentation-hospital-course-and-surgical-outcomes
#15
Darrell J Downs, Giavanna Jadick, Forat Swaid, Sharona B Ross, Alexander S Rosemurgy
Heller myotomy is the "gold-standard" therapy for achalasia, alleviating symptoms by defunctionalizing the lower esophageal sphincter mechanism. Observation has suggested many differences between young and old patients with achalasia, raising the question: is achalasia in younger patients a different disorder than it is in older patients? This study was undertaken to answer this question. With Institutional Review Board approval, 648 patients undergoing laparoscopic Heller myotomy from 1992-2016 were prospectively followed up...
September 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28953511/therapeutic-outcome-of-achalasia-based-on-high-resolution-manometry-a-korean-multicenter-study
#16
Hyuk Lee, Hyunsoo Chung, Tae Hee Lee, Kyoung Sup Hong, Young Hoon Youn, Jung Ho Park, Hyung Seok Park, Hyojin Park
BACKGROUND: Because achalasia subtype is associated with therapeutic response, it is possible that regional differences in subtype distribution could lead to differences in therapeutic outcomes. STUDY QUESTION: We aimed to evaluate and compare high-resolution manometry (HRM) profiles among the different subtypes of achalasia and to elucidate predictive factors associated with treatment outcomes. STUDY DESIGN: Patients who were diagnosed with achalasia using HRM at 4 Korean university hospitals were retrospectively identified and analyzed...
September 11, 2017: American Journal of Therapeutics
https://www.readbyqxmd.com/read/28935197/laparoscopic-heller-myotomy-after-previous-roux-en-y-gastric-bypass
#17
T Javier Birriel, Leonardo Claros, Maher El Chaar
No abstract text is available yet for this article.
August 25, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/28924729/dor-vs-toupet-fundoplication-after-laparoscopic-heller-myotomy-long-term-randomized-controlled-trial-evaluated-by-high-resolution-manometry
#18
Gonzalo Torres-Villalobos, Enrique Coss-Adame, Janette Furuzawa-Carballeda, Fernanda Romero-Hernández, Blanca Blancas-Breña, Samuel Torres-Landa, Axel Palacios-Ramírez, Edgar Alejandro-Medrano, Axel Hernández-Ávila, Athenea Flores-Najera, Lourdes Margarita Ávila Escobedo, Cecilia Ramírez Angulo, Angélica Rodríguez-Garcés, Miguel Ángel Valdovinos
BACKGROUND: Laparoscopic Heller myotomy (LHM) with partial fundoplication is an effective treatment for achalasia. However, the type of fundoplication is still a subject of debate. AIM: The aim of the study is to identify which partial fundoplication leads to better control of acid exposure, manometric parameters, and symptoms scores. METHODS: A randomized controlled trial was performed to compare Dor vs Toupet fundoplication after LHM. The preoperative diagnosis was made by high-resolution manometry (HRM), upper endoscopy, and barium esophagogram...
September 18, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28919276/-focus-on-achalasia
#19
Marie-Anne Guillaumot, Maximilien Barret, Sarah Leblanc, Mahaut Leconte, Bertrand Dousset, Ammar Oudjit, Frédéric Prat, Stanislas Chaussade
The pathophysiology of achalasia is largely unknown, and involves the destruction of ganglion cell in the esophageal myenteric plexus. High-resolution esophageal manometry is the key investigation. Endoscopic pneumodilatation and laparoscopic Heller myotomy have comparable short-term success rates, around 90%. The main complication after pneumodilatation is esophageal perforation, occurring in about 1% of cases. Peroral endoscopic myotomy is a promising treatment modality, however with frequent post-procedural gastroesophageal reflux...
September 14, 2017: La Presse Médicale
https://www.readbyqxmd.com/read/28867969/an-overview-of-achalasia-and-its-subtypes
#20
Dhyanesh A Patel, Brian M Lappas, Michael F Vaezi
Achalasia is one of the most studied esophageal motility disorders. However, the pathophysiology and reasons that patients develop achalasia are still unclear. Patients often present with dysphagia to solids and liquids, regurgitation, and varying degrees of weight loss. There is significant latency prior to diagnosis, which can have nutritional implications. The diagnosis is suspected based on clinical history and confirmed by esophageal high-resolution manometry testing. Esophagogastroduodenoscopy is necessary to rule out potential malignancy that can mimic achalasia...
July 2017: Gastroenterology & Hepatology
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